The research was designed to examine the contemporary experiences of lesbian,
gay and bisexual people with experience of mental distress, and the current
discourses about lesbian, gay and bisexual identities within mental health services.
The study offers a critical exploration of the impact and significance ofthe
classification and declassification of homosexuality as a form of mental illness.
Homosexuality was formally declassified from the American Psychiatric
Association's Diagnostic and Statistical Manual in 1973, and from the World
Health Organisation's International Classification ofDiseases, in 1993. The
research explores this history contextually, in relation to contemporary mental
health services, lesbian, gay and heterosexual service providers, and lesbian, gay
and bisexual people with experience ofmental distress. The research analyses the
contemporary engagement between psychiatry, medical discourses and lesbian, gay
and bisexual identities, and analyses how ideas of lesbian, gay or bisexual
pathology have continued in present discourses ofmental distress. The study
examines contemporary processes ofdiscrimination and exclusion, and institutional
processes ofpathologisation.
It is argued that discourses ofpathology relating to lesbian, gay and bisexual
identities have changed in the years following the declassification of
homosexuality, but their continuation is made possible through contemporary
discourses of health, wellbeing and individual responsibility. The research
concludes that the history ofpathological thinking has a continuing influence in the
ways that mental health services currently think about, and negotiate lesbian, gay
and bisexual identities, and in the ways that lesbian, gay and bisexual people who
use mental health services understand their own mental distress and sexual
identities. Mental health services produce a specific context, and this context both
problematises and individualises the visibility of lesbian, gay and bisexual
identities.
The research draws from theories ofthe closet, and in particular, the work ofEve
Sedgwick and Steven Seidman in understanding how the closet shifts in
significance over time and is contextually specific. The research also draws from
the work of Sander Gilman in understanding the medicalisation of difference, and
Michel Foucault and Nikolas Rose, in drawing together an understanding ofhow
medical discourses interface with aspects of the selfand with social and cultural
discourses ofsexuality and identity. The thesis is organised in chapters addressing
pathologisation, coming out, and exploring the interface between mental distress
and lesbian, gay and bisexual identities.
The thesis is a feminist-influenced study involving individual semi-structured
interviews with lesbian, gay and bisexual people with experience ofmental distress
(n=23), and with lesbian, gay and heterosexual mental health service providers
(n=18). Service user participants were drawn from mental health drop-ins, and
service provider respondents were drawn from a mental health NHS Trust. The
research took place in London, UK.